title: Multivariate logistic regression analysis for prediction of clinically relevant pancreatic fistula in the early phase after pancreaticoduodenectomy.
abstract: BACKGROUND
  Postoperative pancreatic fistula (PF) remains a major complication after pancreaticoduodenectomy (PD). We aimed to investigate the predictors of clinically relevant PF after PD.
  
  
  METHODS
  We retrospectively analyzed the predictive factors of relevant grade B/C PF using logistic regression analysis of 100 consecutive patients who underwent PD. PF was defined in accordance with the International Study Group on PF (ISGPF).
  
  
  RESULTS
  White blood cell count (WBC) of 73.6 × 10(2) /μl, C-reactive protein (CRP) of 9.3 mg/dl and amylase value in drains (d-amylase) of 647 U/I on postoperative day (POD) 4 were proposed as the cut-off values for predicting grade B/C PF with high accuracy by the receiver operating characteristic (ROC) curve. Multivariate logistic regression analysis revealed that the three factors as significant predictive factors and the predicted probability of detecting grade B/C PF was calculated by the following formula; P = 1/[1 + exp{-(2.033 × WBC+3.269 × CRP+2.698 × d-amylase-4.122)}]. P > 0.5 indicates the prospective incidence of the PF. When the cut-off values of the three significant predictors were substituted into the formula, P always showed above 0.5 if more than two predictors were above their cut-off values, indicating a high probability of grade B/C PF.
  
  
  CONCLUSIONS
  White blood cell count, CRP and d-amylase on POD4 were predictive factors for clinically relevant PF after PD. These findings indicate that our formula is useful for management of drain after PD.
authors.affiliation: Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kosaka
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Kuroda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Suzumura
authors.forename: Yasukane
authors.initials: Y
authors.lastname: Asano
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Okada
authors.forename: Jiro
authors.initials: J
authors.lastname: Fujimoto
mesh_terms: D000368:Aged; D000681:Amylases / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005544:Forecasting; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010185:Pancreatic Fistula / Q000209:etiology*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D012372:ROC Curve
chemical_list: D002097:C-Reactive Protein; D000681:Amylases
keywords: Multivariate logistic regression analysis; Pancreaticoduodenectomy; Prediction of pancreatic fistula